Healthcare Provider Details

I. General information

NPI: 1871944132
Provider Name (Legal Business Name): NEWTON HOMETOWN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S PINE ST STE 108
NEWTON KS
67114-3765
US

IV. Provider business mailing address

PO BOX 188
HILLSBORO KS
67063-0188
US

V. Phone/Fax

Practice location:
  • Phone: 620-654-7330
  • Fax: 620-947-2801
Mailing address:
  • Phone: 620-947-3784
  • Fax: 620-947-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC DRIGGERS
Title or Position: OWNER/MANAGER
Credential:
Phone: 620-654-7330